May 14, 2021

Yunnan Huazhiyuan Medical Technology Co., Ltd. ℅ Boyle Wang Official Correspondent Shanghai Truthful Information Technology Co., Ltd. RM. 608, No. 738, Shangcheng Rd., Pudong Shanghai, Shanghai 200120

Re: K210799 Trade/Device Name: Powder Free Vinyl Patient Examination Gloves Regulation Number: 21 CFR 880.6250 Regulation Name: Non-Powdered Patient Examination Glove Regulatory Class: Class I, reserved Product Code: LYZ Dated: March 17, 2021 Received: March 22, 2021

Dear Boyle Wang:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal

U.S. Food & Drug Administration 10903 New Hampshire Avenue Doc ID# 04017.04.2 5 Silver Spring, MD 20993 www.fda.gov K210799 - Boyle Wang Page 2 statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reporting- combination-products); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531- 542 of the Act); 21 CFR 1000-1050.

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to https://www.fda.gov/medical-devices/medical-device-safety/medical-device-reporting- mdr-how-report-medical-device-problems.

For comprehensive regulatory information about medical devices and radiation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medical- devices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (https://www.fda.gov/medical-devices/device-advice-comprehensive-regulatory- assistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email ([email protected]) or phone (1-800-638-2041 or 301-796-7100).

Sincerely,

For Ryan Ortega, Ph. D Acting Assistant Director DHT4B: Division of Infection Control and Plastic Surgery Devices OHT4: Office of Surgical and Infection Control Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

Vinyl Examination Glove FDA 510(k) Files

510(k) Summary (K210799)

This summary of 510(k) is being submitted in accordance with 21 CFR 807.92.

1.0 Submitter’s Information

Name: Huazhiyuan Medical Technology Co., Ltd. Address: Yangjie Industrial Park,Jianshui County,Honghe Hani and Yi , Yunnan Province,China Phone Number: +86-18252909158 Contact: Yun Gao Date of Preparation: May.12,2021

Designated Submission Correspondent

Mr. Boyle Wang Shanghai Truthful Information Technology Co., Ltd. Room 608, No. 738 Shangcheng Rd., Pudong Shanghai, 200120 China Tel: +86-21-50313932 Email: [email protected]

2.0 Device Information

Trade name: Powder Free Vinyl Patient Examination Glove Common name: Vinyl Patient Examination Glove Classification name: Non-powdered Patient Examination Glove Model(s): XS、S、M、L、XL

3.0 Classification

Production code: LYZ Regulation number: 21CFR880.6250 Classification: Class I Panel: General Hospital

4.0 Predicate Device Information

Manufacturer: Hebei Hongtai Plastic Products Company Limited Device: Vinyl Patient Examination Gloves (White, Blue, Yellow) 510(k) number: K163168

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5.0 Indication for Use

The Powder Free Vinyl Patient Examination Glove is a disposable device intended for medical purposes that is worn on the examiner’s hands to prevent contamination between patient and examiner.

6.0 Device Description

The subject device is powder free vinyl patient examination gloves. The subject device is colorless. The design of subject device is addressing the standards as ASTM D6124, ASTM D5151, and ASTM D5250. The subject device is non- sterile.

7.0 Technological Characteristic Comparison Table

Table1-General Comparison Item Subject device Predicate device Comparison 510(k) number K210799 K163168 Different Product Code LYZ LYZ Same Regulation No. 21CFR880.6250 21CFR880.6250 Same Class I I Same Intended Use Powder Free Vinyl The Vinyl Examination Same Patient Examination Glove (White, Blue, or Glove is a disposable Yellow) is a disposable device intended for device intended for medical purposes that is medical purposes that is worn on the examiner’s worn on the examiner’s hands to prevent hands to prevent contamination between contamination between patient and examiner. patient and examiner. Powdered or Powdered free Powdered free Same Powered free Design Feature Ambidextrous Ambidextrous Same Labeling Single use, powder free, Single use, powder free, Similar Information device color, device device color, device name, glove size and name, glove size and quantity, Vinyl quantity, Vinyl Examination Gloves, Examination Gloves, Non-Sterile Non-Sterile

Table2 Device Dimensions Comparison Predicate Device Designation Size Tolerance (K163168) XS S M L XL

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Length, mm 230 230 235 245 245 min Width, mm 80 85 95 105 115 ±5 Thickness, mm: Finger 0.05 min Palm 0.08 min Subject Device Designation Size Tolerance XS S M L XL Length, mm 230 230 230 230 230 min Width, mm 75 85 95 105 115 ±5 Thickness, mm: Finger 0.08 min Palm 0.08 min Remark Similar Analysis: The physical dimensions are different with that of the predicate, but they all meet the requirements of ASTM D5250,so the differences do not raise any new safety or performance questions.

Table3 Performance Comparison Item Subject device Predicate device Comparison Colorant Clear White, Blue, Same Yellow Physical Before Tensile 11MPa, min 15MPa, min Different Properties Aging Strength Ultimate 300%min 380%min Different Elongation After Tensile 11MPa, min 15MPa, min Different Aging Strength Ultimate 300%min 380%min Different Elongation Comply with ASTM D5250 Comply with Same ASTM D5250 Freedom from Holes Be free from Be free from holes Same holes when when tested in tested in accordance with accordance with ASTM D5151 ASTM D5151 AQL=2.5 AQL=2.5 Powder Content ＜ 0.02 mg per Meet the Similar glove requirements of ASTM D6124 Analysis: The tensile strength and ultimate elongation are different with that of the predicate, but they all meet the requirements of ASTM D5250,so the differences do not raise any new safety or performance questions.

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Table4 Safety Comparison Item Subject device Predicate device Comparison Material Vinyl Vinyl Same Biocompatibility Irritation Under the Comply with Same conditions of the ISO10993-10 study, not an irritant Sensitization Under conditions of the study, not a sensitizer. Cytotoxicity Under conditions of Not provided Different the study, did not show potential toxicity to L-929 cells. Label and Labeling Meet FDA’s Meet FDA’s Same Requirement Requirement

8.0 Discussion of Non-clinical Testing

Non-clinical tests were conducted to verify that the proposed device met all design specifications. The test results demonstrated that the proposed device complies with the following standards: ISO 10993-10:2010 Biological Evaluation Of Medical Devices - Part 10: Tests For Irritation And Skin Sensitization. ISO 10993-5:2009 Biological Evaluation Of Medical Devices - Part 5: Tests For In Vitro Cytotoxicity ASTM D6124-06 (Reapproved 2017), Standard Test Method for Residual Powder on Medical Gloves ASTMD5151-19 Standard Test Method for Detection of Holes in Medical Gloves. ASTM D5250-19, Standard Specification for Poly (vinyl chloride) Gloves for Medical Application.

9.0 Clinical Test Conclusion Clinical testing is not needed for this device.

10.0 Conclusion

The conclusions drawn from the nonclinical tests demonstrate that the

4 of page 4 Vinyl Examination Glove FDA 510(k) Files proposed device is as safe, as effective, and performs as well as or better than the legally marketed predicated device.

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